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YOUR PERSONAL HEALTH & PREVENTIVESCREENINGS RECORD

HealthyWomen (formerly the NationalWomens Health Resource Center, Inc.),is the leading independent not-for-prothealth information source for women.HealthyWomen develops and distributesup-to-date and objective womens healthinformation based on the latest advances

in medical research and practice. Healthy Women believes allwomen should have access to the most trusted and reliablehealth information.157 BROAD STREET, SUITE 106, RED BANK, NJ 07701877.986.9472 WW W.HEALTHYWOMEN.ORG

The American Academy of NursePractitioners (AANP) was formed in 1985to provide nurse practitioners (NPs) witha unied way to network and advocatefor NP issues. It is the largest and only

full-service national professional membership organization for NPs

of all specialties, representing the interests of the more than140,000 NPs in the United States. AANP continually advocates atlocal, state and federal levels for the recognition of NPs as providersof high-quality, cost-effective and personalized health care.PO BOX 12846, AUSTIN, TX 78711512.442.4262 WWW.AANP.ORG

Womans Day magazine helps over 20million readers Live Well Every Day. Inevery issue youll nd easy solutions,inspirational stories and helpful advice

for all areas of your lifefrom organizing your home to taking chargeof your health and cooking great meals. For 78 years, WomansDay has researched the best information and found out what youneed to know to make your life easier, less stressful and more fun.1271 AVENUE OF THE AMERICAS, NEW YORK, NY 10020212.767.6000 WWW.WOMANSDAY.COM

TH E PA SSPO RT TO G O O D H EA LTH CA MPA IG N IS FU N D ED BY A N ED U CATIO N A L G RA N T FRO M N O VA RTIS.


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THIS RECORD BELONGS TO

EMERGENCY CONTACT %

HEALTH INSURANCE COMPANY %

HEALTH INSURANCE GROUP # HEALTH INSURANCE ID #

NAME

AD DR ES S

PHONE CELL PHONE

DATE OF BIRTH BLOOD TYPE

AL LE RG IE S/ HE AL TH CO ND IT IO NS

PRIMARY CARE PROVIDER %

SPECIALIST %

PHARMACY %

HOSPITAL PREFERENCE ADDRESS

Youre Worththe Time

Getting recommended preventive healthscreenings can do as much for your overallhealth as any other health-related behavior.

Use this record to keep track of personalhealth information and the results

of your screening tests.

PRODUCED BY HEALTHYWOMEN.ORGAND THE AMERICAN ACADEMY

OF NURSE PRACTITIONERS AANP .


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BLOOD PRESSURE READING : Identies blood pressure rates; higherthan normal readings could mean an incr eased risk of heart disease and stroke.

BONE MINERAL DENSITY TEST: Identies low bone mass or weakbone structure, risks for osteoporosis, a condition that weakens bonesmaking them brittle and more likely to fracture.

CHLAMYDIA TEST: Identies chlamydia, a sexually transmitteddisease, allowing early treatment and reducing spread of the disease.

CLINICAL BREAST EXAMINATION: A visual and physical examination

of your breasts for abnormalities by a health care professional.

COLONOSCOPY : Identies (and removes) precancerous polyps orearly cancers from the colon.

DIGITAL RECTAL EXAM: Helps nd early signs of colon cancer in theanal canal and lower rectum. Because of its limitations, it is notrecommended as the only test for colorectal cancer.

DIAGNOSTIC TEST : If a screening test is positive, diagnostic testing

is done to positively identif y the health concern. Biopsy, magneticresonance imagin g and ultrasound are some examples.

FASTING LIPOPROTEIN TEST : Identies HDL- and LDL-cholesteroland triglyceride levels in your blood; abnormal ranges increase yourrisk for heart disease and stroke.

FASTING PLASMA GLUCOSE TEST: Identies blood sugar levels;higher than normal ranges could mean an increased risk for diabetes.

FECAL OCCULT BLOOD TEST : Tests for blood in the stool; providesearly warning about colon cancer, but not as specic as colonscopy foridentifying cancer or precancer.

HUMAN PAPILLOMAVIRUS HPV TEST: Screens for the humanpapillomavirus. Helps identify women at risk for developing cervicalcancer. Recommended with the Pap test for women 30 and older andwomen with abnormal Pap results.

MAMMOGRAM: This x-ray exam of the breast is used to detect andevaluate breast abnormalities, most often in women who dont haveany breast symptoms, but also in women who do.

PAP TEST: Evaluates a cell sample from your cervix for abnormalitiesthat could indicate pre- or early cervical cancer.

PELVIC EXAM: An external and internal examination of your pelvicorgans.

SCREENING TEST: Looks for or screen s for medical conditionsbefore any symptoms are visible.

SEXUALLY TRANSMITTED DISEASE (STD) SCREENING: Helpsprevent spread of HIV and other STDs, many of which can only bedetected through testing.

THYROID TEST: Identies over- or underactive thyroid conditions,both of which are treatable, but which can lead to more seriousconditions when left untreated.

VISION SCREENING : Identies potential vision problems, includingsymptoms of macular degeneration, glaucoma and eye disorders.

PREVENTIVEHEALTHSCREENINGS

AT A GLANCE

Use this list to help you betterunderstand specic preventivehealth screening terms.


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HEALTH CARE PROVIDERS

PRIMARY CARE %

DENTISTRY %

DERMATOLOGY %

SPECIALIST %

SPECIALIST %

SPECIALIST %

SPECIALIST %

SPECIALIST %

SPECIALIST %

SPECIALIST %

HOSPITAL %

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MY HEALTH SCREENINGS AT A GLANCE

DATE BLOOD CHOLESTER OL OTHER PRESSURE LEVEL

NOTES


NOTES


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HEALTH SCREENINGS

BONE MINERAL DENSITY TESTDATE DATE DATE DATE DATE DATE

CLINICAL BREAST EXAMDATE DATE DATE DATE DATE DATE

COLON CANCER SCREENING

DATE DATE DATE DATE DATE DATE

DENTAL CHECKUPDATE DATE DATE DATE DATE DATE

HEARING TESTDATE DATE DATE DATE DATE DATE

PELVIC EXAMDATE DATE DATE DATE DATE DATE

GLAUCOMA/MACULAR DEGENERATION SCREENINGDATE DATE DATE DATE DATE DATE

SKIN EXAMDATE DATE DATE DATE DATE DATE

MAMMOGRAMDATE DATE DATE DATE DATE DATE

VISION EXAMDATE DATE DATE DATE DATE DATE

PAP TESTDATE DATE DATE DATE DATE DATE

OTHER DATE DATE DATE DATE DATE DATE


HEALTH SCREENINGS

BONE MINERAL DENSITY TESTDATE DATE DATE DATE DATE DATE

CLINICAL BREAST EXAMDATE DATE DATE DATE DATE DATE

COLON CANCER SCREENING

DATE DATE DATE DATE DATE DATE

DENTAL CHECKUPDATE DATE DATE DATE DATE DATE

HEARING TESTDATE DATE DATE DATE DATE DATE

PELVIC EXAMDATE DATE DATE DATE DATE DATE

GLAUCOMA/MACULAR DEGENERATION SCREENINGDATE DATE DATE DATE DATE DATE

SKIN EXAMDATE DATE DATE DATE DATE DATE

MAMMOGRAMDATE DATE DATE DATE DATE DATE

VISION EXAMDATE DATE DATE DATE DATE DATE

PAP TESTDATE DATE DATE DATE DATE DATE




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MEDICATION RECORD

MEDICATION DATE STRENGTH FREQUENCY

PROVIDER CONDITION SIDE EFFECT













MEDICATION RECORD
















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OVER THE COUNTER MEDICATION RECORD















OVER THE COUNTER MEDICATION RECORD
















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HEALTHRESOURCES

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American Cancer Society800.227.2345www.cancer.org

American DiabetesAssociation800.342.2383www.diabetes.org

American Heart Association800.242.8721www.americanheart.org

Centers for DiseaseControl and Prevention800.232.4636www.cdc.gov

Cover the Uninsured800.234.1317covertheuninsured.orgFind resources for health carecoverage in your state

National Breast andCervical Cancer EarlyDetection Program800.232.4636www.cdc.gov/cancer/nbccedpFor free and low-costmammograms and Pap tests

National OsteoporosisFoundation 800.231.4222www.nof.org

Prevent Cancer Foundation800.227.2732www.preventcancer.org

Quality Check www.qualitycheck.orgCheck quality and availability ofhealth services through this nationaldirectory created by the JointCommission, an independent,not-for-prot organization thataccredits and certies more than15,000 U.S. health care organizations

WomenHeartThe National Coalition forWomen with Heart Disease202.728.7199

www.womenheart.org

Preventive Health Screening Questionsto Ask Your Health Care Professional

1. What are my risks for the condition this screening isdesigned to detect?

2. How often should I be screened for this condition?3. What should I do to prepare for this screening?4. Where is the screening done?5. Will my insurance pay for this screening? Are there

other ways to pay for it?

Things to Take With You When MeetingWith Your Health Care Professional

o Insurance card/other documentationo List of all conditions for which you are currently

being treatedo List of all prescription and over-the-counter

medications you take including vitamins andherbal supplements

o List/dates of previous surgeries or hospitalizationso List of all allergies to medications, foods, etc.o List/dates of immunizations/vaccinationso List of all other health care providers you currently see

025 passport good health

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